The midlife rhinoplasty: the rise in the over-40 nose job

Rhinoplasty has traditionally been viewed as a procedure for younger people. Teens and young adults often seek rhinoplasty to improve the appearance of their noses, boosting confidence and self-esteem, particularly in recent years with the advent of social media and selfies.

However, an increasing number of patients are now seeking a midlife rhinoplasty.

In fact, the most recent data from the American Society of Plastic Surgeons shows that patients aged 40 to 54 now account for the same share of the rhinoplasty market as patients in their 20s.

It’s true that selfie culture has made us all more aware of our angles, but there are many reasons why patients might delay a nose job until later in life.

“I’ve seen many older patients who have decided now is the right time, and they have a clearer idea of what they want. It’s no longer a matter of peer pressure,” Mr Annakan Navaratnam explains.

Why now?

Partly this is due to the reduced stigma surrounding plastic surgery. Gen X-ers may have been unhappy with the appearance of their noses since their teenage years, but at the time, cosmetic surgery was not as commonplace as it is now. There is now greater awareness of what can be done to address something that may have long been a concern.

They may now be in a place, career-wise and financially, where they can devote the necessary time and resources to both the surgery and its recovery. Often, they are more emotionally ready for the post-surgery period, carefully following the aftercare instructions and any post-op restrictions.

Although older patients typically experience slower healing, with swelling and bruising persisting for several weeks longer than in younger patients, they are more likely to have realistic expectations and dedicate themselves to their recovery, which can actually improve outcomes.

“Some of my younger patients have been very anxious during the recovery stage, often expecting swelling to be very short-lived when it can be present for months. I think there has been a proliferation of videos on social media recently where the cast comes off, and the nose is perfect. Patients don’t realise that this has been filmed many months after surgery.”

The ageing nose

Even for patients who were previously quite happy with the appearance of their nose, it can become their new insecurity as they age.

A common misconception is that the nose continues to grow as we get older. The bone and cartilage do not grow or change, but the ligaments that connect the nasal tissues become less elastic over time, and the nose can start to look longer or wider, and the tip can start to droop. As the skin thins, any bumps and asymmetries might become more noticeable.

In men, the nasal skin can often get thicker and more sebaceous, making the nose appear more bulbous. Other ageing changes to the face, such as a receding chin or sagging cheeks, can make the nose appear more prominent.

Although rhinoplasty is not usually considered an anti-ageing procedure in the same way as a facelift, a recent UCLA study using age-estimating AI tech to compare before-and-afters and found that women looked three years younger after a nose job alone.

“There are also functional changes that occur as the nose ages,” leading London ENT surgeon Annakan explains. “The drooping of the tissues as the ligaments loosen can cause nasal blockages. Inflammatory changes can mean they develop sinusitis or rhinitis that compounds the issue. Septal surgery alone might not resolve the problem, and a septorhinoplasty or rhinoplasty is required.

“Opportunity presents itself through other means, either trauma or functional issues, and they can then address an aesthetic concern that may have been bothering them for a long time.”

This lovely patient underwent a septorhinoplasty after nasal trauma. The improved form and function of her nose after surgery allowed her to breathe freely through her nose, and her sleep quality improved immensely. She was also really happy with the aesthetic improvement to her nose.

“Result is fantastic – my breathing and sleeping are so much better, and my nose is perfectly straight now, or as my daughter put it – I am less beaky now!”

Second time round

Another factor in the increase in midlife rhinoplasties is revision surgery.

There are no official figures, but it’s estimated that approximately 15% of patients who undergo primary rhinoplasty eventually seek revision. This might be because they now want a more age-appropriate appearance, or the original changes to the nose removed too much of the supportive structures, causing deformities and breathing issues.

“Previously, the trend in female rhinoplasty was to create a ‘button’ or ‘ski-slope’ nose with a scooped-out bridge and upturned tip. Women who underwent a rhinoplasty in their late teens and early 20s may now regret these changes as they’ve got older. Or they have run into problems with function.”

The aesthetics of the over-40s nose job

Mr Annakan Navaratnam finds that older patients typically want subtle, conservative refinements that keep the nose in proportion with the rest of the face and align with their cultural identity.

The charming lady sustained a nasal injury, resulting in flattening of the lower two-thirds of her nose and a deviation of the nasal septum. Careful repositioning of the nasal septum and tip sculpting and suture techniques resulted in a refined and natural appearance of the nose.

“Firstly, there is a psychological aspect. They have lived with their nose for most of their adult life and even slight adjustments can have an impact. Older patients typically do not want a drastic change, whereas some of my younger patients have wanted to completely remodel their noses.

“Mature patients have also had time to make a considered decision. If it’s only one aspect they are bothered by, they just want that addressed. This natural approach lines up with my own surgical philosophy.”

To discuss whether rhinoplasty can fulfil your expectations, call +44 (0)203 627 2918 to arrange a consultation with Mr Annakan Navaratnam.